National Centre for Disease Informatics and Research (Indian Council of Medical Research), Nirmal Bhawan, ICMR Complex, Poojanhalli Road, off NH-7, adjacent to Trumpet Flyover of BIAL, Kannamangala Post, Bengaluru 562110, Karnataka, India.
Natl Med J India. 2021 Jan-Feb;34(1):29-35. doi: 10.4103/0970-258X.323661.
The increasing burden of non-communicable diseases in rural areas poses new challenges to an already overburdened health systems. We detail these challenges and identify opportunities to address them. The major challenges in service delivery in rural areas include poor accessibility, shortage of adequate manpower especially specialists in rural areas, irregular supply of medicines and lack of adequate diagnostic facilities. This has led to an increased dependency on the private sector resulting in high out-of-pocket and catastrophic health expenditure. The challenges are amplified by lower health literacy, large pool of informal or untrained healthcare practitioners, and lack of proper referral and follow up. The health system opportunities identified include task-shifting by training of mid-level healthcare providers and practitioners from Indian systems of medicine, widening use of e-health and m-health, community engagement and public-private partnerships. Participatory health governance through community engagement has been shown to improve accountability and quality in health systems. Civil society organizations (CSO) can also improve awareness and health-seeking behaviour. New and evidence-based strategies need to be implemented to address health system challenges for tackling non-communicable diseases in rural areas.
农村地区不断增加的非传染性疾病负担给已经负担过重的卫生系统带来了新的挑战。我们详细说明了这些挑战，并确定了应对这些挑战的机会。农村地区服务提供方面的主要挑战包括交通不便、农村地区合格医务人员特别是专家短缺、药品供应不规律以及缺乏足够的诊断设施。这导致对私营部门的依赖增加，导致高额的自付费用和灾难性的医疗支出。农村地区较低的健康素养、大量的非正式或未经培训的医疗保健从业者以及缺乏适当的转诊和随访，使得这些挑战更加严重。确定的卫生系统机会包括通过培训中级医疗保健提供者和印度医学系统的从业者来转移任务，扩大电子医疗和移动医疗的使用，社区参与和公私伙伴关系。通过社区参与进行参与式卫生治理已被证明可以提高卫生系统的问责制和质量。民间社会组织（CSO）也可以提高意识和寻求健康的行为。需要实施新的基于证据的策略，以解决农村地区非传染性疾病的卫生系统挑战。
